February 01, 2013

Report from insurers criticizes out-of-network provider charges

The national trade association for health insurance plans
released a report today that is critical of providers charging much higher
rates for out-of-network patients (Source: "Report Faults High Fees for
Out-of-Network Care," New York Times, Feb. 1, 2013)

“When you’re out of network, it’s a blank check,” said Karen
Ignagni, president and chief executive of AHIP. “The consumer is vulnerable to
‘anything goes.’ ”

In response to the insurers’ report, the American Medical
Association noted on Thursday that a recent analysis found that doctors’
services account for just 16 percent of health care costs.

“There are outliers in every profession, in every business,”
said Dr. Andrew Y. Kleinman, a plastic surgeon who is vice president of the
Medical Society of the State of New
York.

Ignagni said the high costs sometimes charged to
out-of-network patients could impact how many people enroll for coverage under
the ACA. “Unless we deal with cost, we won’t have affordability,” she said.
“And unless we have affordability, we won’t have people participating” under
the Affordable Care Act.